Provider Demographics
NPI:1285177071
Name:MOHAMAD, ELLIAS
Entity type:Individual
Prefix:
First Name:ELLIAS
Middle Name:
Last Name:MOHAMAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2307 N CONGRESS AVE APT 27
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8607
Mailing Address - Country:US
Mailing Address - Phone:916-690-3638
Mailing Address - Fax:
Practice Address - Street 1:1815 FOREST HILL BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CLARKE SHORES
Practice Address - State:FL
Practice Address - Zip Code:33406-6021
Practice Address - Country:US
Practice Address - Phone:855-217-7625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician